Squamous cell carcinoma of bronchus presenting with Henoch-Schönlein purpura.

Abstract

Injury to the appendix after blunt abdominal trauma Traumatic rupture of the appendix as an isolated visceral injury is exceptionally rare and appears to be unrecorded in Great Britain.This paper reports such a case, speculates on the mechanism of injury, and adds an historical note. Case reportA healthy 36-year-old lorry driver sustained a low velocity crush injury as he was trapped between a stationary and a slow moving vehicle.The patient remained conscious throughout the incident and could subsequently describe a combination of compression and rotation forces applied to the lower thorax and upper abdomen.Examination in the casualty department showed tenderness of the abdomen and left loin.Bowel sounds were present and there were no signs of peritoneal irritation.Microscopic haematuria was detected on reagent strip testing.The only abnormalities seen on x-ray examination were fractures of the left transverse processes of the second, third, and fourth lumbar vertebrae.In the absence of convincing evidence of visceral injury he was initially admitted for observation but when, after four hours, he complained of right shoulder tip pain he was submitted to laparotomy.The abdomen was opened through a right paramedian incision and a little free blood was immediately evident lying in the right paracolic gutter.The source of the bleeding was identified as a long, torn mesoappendix-the appendix itself having been completely severed at the junction of its proximal third and distal two-thirds.The severed portion was located near the hepatic flexure.No other visceral injury was found, although there was considerable retroperitoneal haematoma in the left perinephric region.The proximal portion of the appendix was excised and the stump invaginated to complete the appendicectomy.The patient made an uncomplicated recovery and was discharged on the sixth day.Histological examination of the appendix showed a small faecolith in the severed portion and mild but definite inflammatory changes confined to the mucosa of both portions.Despite the patient's freedom from symptoms before the accident, the features were those of an early (subclinical) acute appendicitis.